老年男性静脉麻醉下经直肠超声引导无痛前列腺穿刺疼痛控制与并发症分析

The Sstudy of the Pain control and Complication of Analgesic Transrectal Ultrasound-Lguided Prostate Biopsy by Intravenous Anesthesia in the Older Men

目的:探讨前列腺特异抗原增高(PSA>4μg/L)老年男性静脉麻醉下经直肠超声引导无痛前列腺穿刺疼痛控制与并发症发生情况。方法:选取96例PSA增高老年男性患者(69±7岁)进行静脉麻醉下直肠超声引导无痛前列腺12针系统穿刺(静脉麻醉组),并选取同期进行前列腺周围神经阻滞麻醉下直肠超声引导前列腺12针系统穿刺的51例PSA增高老年男性患者(67±6岁)为对照组,记录穿刺后30min视觉模拟疼痛评分(VAS)、穿刺时间、麻醉不良事件和并发症发生情况。结果:静脉麻醉组90例(94%)为无疼痛(VAS=0),6例(6%)为轻度疼痛;对照组21例(41%)为轻度疼痛,30例(59%)为中度疼痛。静脉麻醉组平均VAS评分和穿刺时间分别为(0.1±0.3)分和(5.1±1.3)min,显著低于对照组(3.8±1.2)分和(11.3±3.9)min。静脉麻醉组无一例发生麻醉不良事件。静脉麻醉组术后肉眼血尿、大便带血、发热和尿潴留的发生率分别为55%、15%、5%和3%,与对照组的差异无统计学意义(57%、18%、6%和4%)。结论:对于PSA增高老年男性患者,静脉麻醉直肠超声引导无痛前列腺穿刺具有无痛安全准确的优点。

Objective： To investigate the pain control and complication of analgesic transrectal ultrasoundguided prostate biopsy （ATUGPB） by intravenous anesthesia in the older men with evaluated PSA. Methods：The AUGPB with twelve cores by intravenous anesthesia were completed in 96 older men（mean age 69±7 years） with evaluated PSA（〉4 μg/L）, as intravenous anesthesia group. Moreover, fifty-one older men （mean age 67±6 years） were included in this study as control group, and completed the transrectal ultrasound Lguided prostate biopsy with twelve cores under periprostatic nerve block were. The parameters were recorded including biopsy time, visual analog pain scale score （VAS）, anesthetic adverse events and complication. Results： In the intravenous anesthesia group, ninety cases （94 %） have no pain（VAS： 0）and six （6 % ） have mild pain. However, twenty-one cases （41%） have mild pain, and thirty （59%） have moderate pain. The VAS and biopsy time of intravenous anesthesia group were respectively （0. 1± 0.3） and（5.1± 1.3）min, significantly lower those of control group （3.8 ±1.2） and （11.3±3.9）min. No case occur anesthetic adverse events in the intravenous anesthesia group. Moreo ver, there were no significant differences in the incidence of macroscopic hematuria, bloody stool, fever and urinary retention between intravenous anesthesia group and control group（55 %, 15 %, 5 %and 3 % vs 57 %, 18 %, 6 % and 4%）. Conclusions：It is suggested that it is painless, accurate and safe for ATUGPB by intravenous anesthesia in the older men with evaluated PSA.